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Hastanede Yatan Çocuklarda Mikoplazma pnömoni Enfeksiyonunun Nörolojik Belirtileri: Tek Merkezli Bir Deneyim

Year 2022, Volume: 16 Issue: 5, 402 - 408, 20.09.2022
https://doi.org/10.12956/tchd.1053552

Abstract

Amaç: Mikoplazma pnömoni, çocukluk çağında üst ve alt solunum yolu enfeksiyonlarının başlıca nedenlerinden biridir. Nörolojik hastalıklar en sık görülen ekstrapulmoner belirtiler arasındadır. Bu çalışma, M. pnömoni ile ilişkili nörolojik semptomları olan hastaların tedavi özellikleri, klinik ve radyolojik seyri ile ilgili merkezimizin deneyimlerini mevcut kanıtlar ışığında paylaşmayı amaçlamıştır.


Gereç ve Yöntemler:
Hastanede yatan ve primer M. Pnömoni serolojisi pozitif çıkan pediatrik hastalar dahil edilmiştir. M. Pnömoni serolojisi akut dönemde serumda ve mümkünse konvalesan serumda M. Pnömoni spesifik IgM ve immünglobulin G (IgG) enzim immün assay yöntemi kullanılarak bakıldı. Akut dönemde ve hastalık başladıktan 7 gün-4 hafta sonra, konvalesan dönemde alınan serumlarda IgG titresinde dört kat ve üzeri artış M. Pnömoni enfeksiyonu için tanısal kabul edildi. SSS tutulumu olan hastalar demografik, klinik, labarotuvar ve görüntüleme sonuçları eşliğinde değerlendirildi.

Bulgular: Çeşitli nedenlerle Ocak 2019- Aralık 2020 tarihleri arasında hastanemizde yatan 52 hasta primer M. Pnömoni enfeksiyonu doğrulanmıştı. Mikoplazma pnömoni enfeksiyonu doğrulan 52 hastanın 13’ünde (%25) nörolojik semptom ve bulgular olduğu tespit edildi. Klinik, laboratuar ve görüntüleme sonuçları ile birlikte değerlendirildiğinde; 6 olgu (%46) Akut serebellar ataksi, 4 olgu (%30) ensefalit, bir olgu Guillain barre sendromu (GBS), bir olgu optik nörit bir olgu da Longitudinal ekstensif transvers miyelit (LETM) tanısı almıştı.

Sonuç: Mikoplazma pnömoni başlıca solunum yolu patojeni olarak bilinmesine rağmen çeşitli nörolojik rahatsızlıklara da neden olur. Nörolojik tutulumun erken tanı ve tedavisine yönelik en uygun yöntemlerin değerlendirilmesi için hastalığın uzun dönemli yükünü de göz önünde bulundurarak daha ileri çalışmalara ihtiyaç vardır.

References

  • Waites KB, Talkington DF. Mycoplasma pneumoniae and its role as a human pathogen. Clin Microbiol Rev 2004;17:697-728.
  • Christie LJ, Honarmand S, Talkington DF, Shilpa S, Gavali, Preas C, et al. Pediatric encephalitis: what is the role of Mycoplasma pneumoniae? Pediatrics 2007;120: 305-13.
  • Ponka A. Central nervous system manifestations associated with serologically verified Mycoplasma pneumoniae infection. Scand J Infect Dis1980; 12:175–84.
  • Yis U, Kurul, S H Cakmakçi H, Dirik E. Mycoplasma pneumoniae: nervous system complications in childhood and review of the literature. Eur J Pediatr 2008; 167:973–8.
  • Pillai SC, Hacohen Y, Tantsis E, Prelog K, Merheb V, Kesson A, et al. Infectious and autoantibody-associated encephalitis: clinical features and long-term outcome. Pediatrics 2015; 135:974–84.
  • Meyer Sauteur PM, Huizinga R, Tio-Gillen A P, Roodbol J, Hoogen boezem T, Jacobs E, et al. Mycoplasma pneumoniae triggering the Guillain-Barré syndrome: a case-control study. Ann Neurol 2016;80:566–80.
  • Al-Zaidy SA, Mac Gregor D, Mahant S, Richardson SE, Bitnun A. Neurological complications of PCR-proven M. pneumoniae infections in children: Prodromal illness duration may reflect pathogenetic mechanism. Clin Infect Dis 2015;61:1092–8.
  • Thomas NH Collins JE, Robb SA, Robinson RO. Mycoplasma pneumoniae infection and neurological disease. Arch Dis Child 1993;69:573–6 .
  • Loewenbrück KF, Pütz V, Schäfer J, Reichmann H, Storch A. Parainfectious polyneuropathy and miller-fisher-syndrome in combination with anemia in Mycoplasma pneumoniae infection. Fortschr Neurol Psychiatr 2008;76:361–5.
  • Tsiodras S, Kelesidis I, Kelisidis T, Stamboulis E, Giamarellou H. Central nervous system manifestations of Mycoplasma pneumoniae infections. J Infect 2005;51:343-54.
  • Shah SS. Mycoplasma pneumoniae. In Principles and Practice of Pediatric Infectious Diseases.3rd ed. Long SS, Pickering LK, Prober CG (eds). Churchhill, Livingstone 2008; 979-84.
  • Narita M. Pathogenesis of extrapulmonary manifestations of Mycoplasma pneumoniae infection with special reference to pneumonia. J Infect Chemother 2010;16:162–9.
  • Venkatesan A, Tunkel AR, Bloch KC, Lauring AS, Sejvar, Bitnun A, et al. International Encephalitis Consortium. Case definitions, diagnostic algorithms, and priorities in encephalitis: consensus statement of the international encephalitis consortium. Clin Infect Dis 2013;57:1114–28.
  • Proposed diagnostic criteria and nosology of acute transverse myelitis. Transverse Myelitis Consortium Working Group. Neurology 2002;59:499–505.
  • Kammer J, Ziesing S, Davila LA, Bultmann E, Illsinger S, Das AM, et al. Neurological manifestations of Mycoplasma pneumoniae infection in hospitalized children and their long-term follow-up. Neuropediatrics 2016;47:308-17.
  • Koskiniemi M. CNS manifestations associated with Mycoplasma pneumoniae infections: summary of cases at the University of Helsinki and review. Clin Infect Dis 1993;17: 52–7.
  • Daxboeck F. Mycoplasma pneumoniae central nervous system infections. Curr Opin Neurol 2006;19:374-8.
  • Guleria R, Nisar N, Chawla TC, Biswas NR. Mycoplasma pneumonia and central nervous system complications: a review. J Lab Clin Med 2005; 146:55-63.
  • Nussinovitch M, Prais D, Volovitz B, Shapiro R, Amir J. Post-infectious acute cerebellar ataxia in children. Clin Pediatr 2003;42:581-4.
  • Kim SM, Heo JS, Shim EJ, LeeDH, Cho BJ, Kim DH, et al. Two cases of central nervus system complication caused by Mycoplasma pneumonia infection. Korean J Pediatr 2008;51:533-7.
  • Meyer Sauteur PM, Streuli JC, Iff T, Goetschel P. Mycoplasma pneumoniae-associated encephalitis in childhood--nervous system disorder during or after a respiratory tract infection. Klin Padiatr 2011;223:209-13.
  • D’Alonzo R, Mencaroni E, Di Genova L, Laino D, Principi N, Esposito S. Pathogenesis and treatment of neurologic diseases associated with mycoplasma pneumoniae infection. Front Microbiol 2018;9:2751
  • Salzman MB, Sood SK, Slavin ML, Rubin LG. Ocular manifestations of Mycoplasma pneumoniae infection. Clin Infect Dis 1992;14:1137–9.
  • Chiang WY, Huang HM. Bilateral monosymptomatic optic neuritis following Mycoplasma pneumoniae infection: a case report and literature review. Indian J Ophthalmol 2014;62:724–7.
  • Rappoport D, Goldenberg-Cohen N, Luckman J, Leiba H. Parainfectious optic neuritis: manifestations in children vs adults. J Neuroophthalmol 2014;34:122–9.
  • Milla E, Zografos L, Piguet B. Bilateral optic papillitis following Mycoplasma pneumoniae pneumonia. Ophthalmologica 1998;212:344–6.
  • Ozkale Y, Erol I, Coban-Karatas M, Alkan O. Optic neuritis as a presenting symptom of Mycoplasma pneumoniae infection. Turk J Pediatr 2015;57:401–6.
  • Esposito S, Longo MR. Guillain-Barre´ syndrome. Autoimmun Rev 2017;16: 96-101.
  • Meyer Sauteur PM, Jacobs BC, Spuesens EB, Jacobs E, Nadal D, Vink C, et al. Antibody responses to Mycoplasma pneumoniae: role in pathogenesis and diagnosis of encephalitis? PLoS Pathog 2014;12:e1003983.

Neurological Manifestations of Mycoplasma pneumoniae Infection in Hospitalized Children: A Single-Center Experience

Year 2022, Volume: 16 Issue: 5, 402 - 408, 20.09.2022
https://doi.org/10.12956/tchd.1053552

Abstract

Objective: Mycoplasma pneumoniae is one of the major causes of upper and lower respiratory tract infection in childhood. Neurological diseases are among the most common extrapulmonary manifestations.This study aimed to share our center’s experience regarding the treatment characteristics and clinical and radiological course of patients with M. pneumoniae-related neurological symptoms in light of the available evidence.

Material and Methods: The study included in hospitalized patients with positive primary M. pneumoniae serology M. pneumoniae serology was examined in serum from the acute period and, if possible, convalescent serum (1-4 weeks after disease onset) using M. pneumoniae-specific immunoglobulin M (IgM) and IgG enzyme-linked immunoassay. A 4-fold or greater increase in IgG titer between acute and convalescent serum samples was considered diagnostic for M. pneumoniae infection. The clinical, laboratory, and imaging results and demographic data of patients with CNS involvement were evaluated.

Results: Review of the patients’ charts showed that 13 (25%) of the 52 patients with confirmed M. pneumoniae infection had neurological symptoms and findings. When evaluated together with clinical, laboratory, and imaging results, 6 patients were diagnosed with acute cerebellar ataxia, 4 patients with encephalitis, and 1 patient each with GBS, optic neuritis, and longitudinally extensive transverse myelitis.


Conclusion:
Although M. pneumoniae is known as mainly a respiratory pathogen, it also causes various neurological disorders. Although all of our patients had symptoms of respiratory tract infection, it has been shown that that M. pneumoniae can also cause neurological disease without respiratory symptoms. Further studies are needed to evaluate the most appropriate methods for early diagnosis and treatment of neurological involvement, considering the long-term burden of the disease.

References

  • Waites KB, Talkington DF. Mycoplasma pneumoniae and its role as a human pathogen. Clin Microbiol Rev 2004;17:697-728.
  • Christie LJ, Honarmand S, Talkington DF, Shilpa S, Gavali, Preas C, et al. Pediatric encephalitis: what is the role of Mycoplasma pneumoniae? Pediatrics 2007;120: 305-13.
  • Ponka A. Central nervous system manifestations associated with serologically verified Mycoplasma pneumoniae infection. Scand J Infect Dis1980; 12:175–84.
  • Yis U, Kurul, S H Cakmakçi H, Dirik E. Mycoplasma pneumoniae: nervous system complications in childhood and review of the literature. Eur J Pediatr 2008; 167:973–8.
  • Pillai SC, Hacohen Y, Tantsis E, Prelog K, Merheb V, Kesson A, et al. Infectious and autoantibody-associated encephalitis: clinical features and long-term outcome. Pediatrics 2015; 135:974–84.
  • Meyer Sauteur PM, Huizinga R, Tio-Gillen A P, Roodbol J, Hoogen boezem T, Jacobs E, et al. Mycoplasma pneumoniae triggering the Guillain-Barré syndrome: a case-control study. Ann Neurol 2016;80:566–80.
  • Al-Zaidy SA, Mac Gregor D, Mahant S, Richardson SE, Bitnun A. Neurological complications of PCR-proven M. pneumoniae infections in children: Prodromal illness duration may reflect pathogenetic mechanism. Clin Infect Dis 2015;61:1092–8.
  • Thomas NH Collins JE, Robb SA, Robinson RO. Mycoplasma pneumoniae infection and neurological disease. Arch Dis Child 1993;69:573–6 .
  • Loewenbrück KF, Pütz V, Schäfer J, Reichmann H, Storch A. Parainfectious polyneuropathy and miller-fisher-syndrome in combination with anemia in Mycoplasma pneumoniae infection. Fortschr Neurol Psychiatr 2008;76:361–5.
  • Tsiodras S, Kelesidis I, Kelisidis T, Stamboulis E, Giamarellou H. Central nervous system manifestations of Mycoplasma pneumoniae infections. J Infect 2005;51:343-54.
  • Shah SS. Mycoplasma pneumoniae. In Principles and Practice of Pediatric Infectious Diseases.3rd ed. Long SS, Pickering LK, Prober CG (eds). Churchhill, Livingstone 2008; 979-84.
  • Narita M. Pathogenesis of extrapulmonary manifestations of Mycoplasma pneumoniae infection with special reference to pneumonia. J Infect Chemother 2010;16:162–9.
  • Venkatesan A, Tunkel AR, Bloch KC, Lauring AS, Sejvar, Bitnun A, et al. International Encephalitis Consortium. Case definitions, diagnostic algorithms, and priorities in encephalitis: consensus statement of the international encephalitis consortium. Clin Infect Dis 2013;57:1114–28.
  • Proposed diagnostic criteria and nosology of acute transverse myelitis. Transverse Myelitis Consortium Working Group. Neurology 2002;59:499–505.
  • Kammer J, Ziesing S, Davila LA, Bultmann E, Illsinger S, Das AM, et al. Neurological manifestations of Mycoplasma pneumoniae infection in hospitalized children and their long-term follow-up. Neuropediatrics 2016;47:308-17.
  • Koskiniemi M. CNS manifestations associated with Mycoplasma pneumoniae infections: summary of cases at the University of Helsinki and review. Clin Infect Dis 1993;17: 52–7.
  • Daxboeck F. Mycoplasma pneumoniae central nervous system infections. Curr Opin Neurol 2006;19:374-8.
  • Guleria R, Nisar N, Chawla TC, Biswas NR. Mycoplasma pneumonia and central nervous system complications: a review. J Lab Clin Med 2005; 146:55-63.
  • Nussinovitch M, Prais D, Volovitz B, Shapiro R, Amir J. Post-infectious acute cerebellar ataxia in children. Clin Pediatr 2003;42:581-4.
  • Kim SM, Heo JS, Shim EJ, LeeDH, Cho BJ, Kim DH, et al. Two cases of central nervus system complication caused by Mycoplasma pneumonia infection. Korean J Pediatr 2008;51:533-7.
  • Meyer Sauteur PM, Streuli JC, Iff T, Goetschel P. Mycoplasma pneumoniae-associated encephalitis in childhood--nervous system disorder during or after a respiratory tract infection. Klin Padiatr 2011;223:209-13.
  • D’Alonzo R, Mencaroni E, Di Genova L, Laino D, Principi N, Esposito S. Pathogenesis and treatment of neurologic diseases associated with mycoplasma pneumoniae infection. Front Microbiol 2018;9:2751
  • Salzman MB, Sood SK, Slavin ML, Rubin LG. Ocular manifestations of Mycoplasma pneumoniae infection. Clin Infect Dis 1992;14:1137–9.
  • Chiang WY, Huang HM. Bilateral monosymptomatic optic neuritis following Mycoplasma pneumoniae infection: a case report and literature review. Indian J Ophthalmol 2014;62:724–7.
  • Rappoport D, Goldenberg-Cohen N, Luckman J, Leiba H. Parainfectious optic neuritis: manifestations in children vs adults. J Neuroophthalmol 2014;34:122–9.
  • Milla E, Zografos L, Piguet B. Bilateral optic papillitis following Mycoplasma pneumoniae pneumonia. Ophthalmologica 1998;212:344–6.
  • Ozkale Y, Erol I, Coban-Karatas M, Alkan O. Optic neuritis as a presenting symptom of Mycoplasma pneumoniae infection. Turk J Pediatr 2015;57:401–6.
  • Esposito S, Longo MR. Guillain-Barre´ syndrome. Autoimmun Rev 2017;16: 96-101.
  • Meyer Sauteur PM, Jacobs BC, Spuesens EB, Jacobs E, Nadal D, Vink C, et al. Antibody responses to Mycoplasma pneumoniae: role in pathogenesis and diagnosis of encephalitis? PLoS Pathog 2014;12:e1003983.
There are 29 citations in total.

Details

Primary Language English
Subjects ​Internal Diseases
Journal Section ORIGINAL ARTICLES
Authors

Halil Celik 0000-0002-2022-2909

Erhan Aksoy 0000-0002-7210-6715

Ülkühan Öztoprak 0000-0002-7309-3215

Meltem Akçaboy 0000-0002-0862-3961

Mutlu Uysal Yazici 0000-0001-7377-4718

Zeynep Savas Sen 0000-0003-4671-6082

Deniz Yüksel 0000-0001-8990-023X

Publication Date September 20, 2022
Submission Date January 4, 2022
Published in Issue Year 2022 Volume: 16 Issue: 5

Cite

Vancouver Celik H, Aksoy E, Öztoprak Ü, Akçaboy M, Uysal Yazici M, Savas Sen Z, Yüksel D. Neurological Manifestations of Mycoplasma pneumoniae Infection in Hospitalized Children: A Single-Center Experience. Türkiye Çocuk Hast Derg. 2022;16(5):402-8.


The publication language of Turkish Journal of Pediatric Disease is English.


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